L10: Abdominal Exam Flashcards
Abdominal Landmarks
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What are the abdominal quadrants?
What are the abdominal sections?
- Quadrants
- Right Upper Quadrant (RUQ)
- Left Upper Quadrant (LUQ)
- Right Lower Quadrant (RLQ)
- Left Lower Quadrant (LLQ)
- Sections
- Epigastric
- Umbilica
- Hypograstric or Suprapubic
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Abdominal Quadrants
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What sequence do you perform the following elements in?
Auscultation, Inspection, Palpation, Percussion
- Inspection
- Auscultation
- Percussion
- Palpation
Abdominal Exam: Inspection
What are you inspecting for?
- General appearance of the patient
- Contour/Shape/Symmetry
- Distention
- Hernias/Bulges/Masses
- Peristalsis/Pulsations
- Skin markings
Inspection: Contour/Shape
Define:
Flat
Rounded
Scaphoid
Protuberant
![](https://s3.amazonaws.com/brainscape-prod/system/cm/361/499/279/a_image_thumb.png?1635570748)
Protuberant Abdomens
What can cause protruberant abdomens?
![](https://s3.amazonaws.com/brainscape-prod/system/cm/361/499/296/a_image_thumb.png?1635570807)
Umbilical Hernia
What is it?
Herniation of abdominal contents through a defective umbilical ring
![](https://s3.amazonaws.com/brainscape-prod/system/cm/361/499/324/a_image_thumb.png?1635570913)
Incisional Hernia
What is it?
Herniation of abdominal contents through a previous incision site
![](https://s3.amazonaws.com/brainscape-prod/system/cm/361/499/367/a_image_thumb.png?1635570969)
Diastasis Recti
What is it?
How to test/observe?
Benign, separation of the rectus abdominis muscles
Abdominal contents form midline ridge
Obvious with flexion of neck “lift your head up”
![](https://s3.amazonaws.com/brainscape-prod/system/cm/361/499/387/a_image_thumb.png?1635571026)
Ventral Wall Hernias
When to check for ventral wall hernias?
Technique?
- If you suspect but do not see an umbilical or incisional hernia
-
Techniques:
- Ask patient to raise head and shoulders off the table
- Ask patient to raise both legs off the table
- Ask patient to perform Valsalva maneuver
- Bulge of hernia will usually appear with this action
Peristalsis & Pulsations
What are they?
Indication if observed?
- Peristalsis (visible waves of movement seen beneath the skin)
- Can be seen in very thin people
- Increased peristaltic waves of intestinal obstruction
- Pulsations
- Normal aortic pulsation is frequently visible in epigastrium
- Look for increased pulsation of abdominal aortic aneurysm
Skin Markings: Ecchymosis
What is it?
Ecchymosis: a discoloration of the skin resulting from bleeding underneath, typically caused by bruising
Can be seen in intraperitoneal or retroperitoneal hemorrhage
![](https://s3.amazonaws.com/brainscape-prod/system/cm/361/499/468/a_image_thumb.png?1635571304)
Skin Markings: Striae
Pink-purple striae of Cushings
![](https://s3.amazonaws.com/brainscape-prod/system/cm/361/499/500/a_image_thumb.png?1635571406)
Skin Markings: Dilated Veins
- Abdominal wall veins normally scarcely visible
- Prominent veins most commonly suggest portal hypertension from cirrhosis
- Portal hypertension promotes collateral venous circulation radiating from the umbilicus to the abdominal wall (Caput medusa)
![](https://s3.amazonaws.com/brainscape-prod/system/cm/361/499/538/a_image_thumb.png?1635571578)
Auscultation
Purpose of auscultation
Why is auscultation performed second?
-
Purpose:
- Assess bowel sounds noting frequency and character
- Assess for bruits (atherosclerotic disease)
-
*Second phase of abdominal exam
- Done before percussion or palpation to evaluate the activity of the intestines before altering bowel sounds with abdominal wall pressure
Bowel Sounds
- Where do you auscultate for bowel sound?
- What is the frequency of bowel sounds?
- Character of bowel sounds:
- What is normal?
- What is abnormal?
- Generally completed in all four quadrants
- Frequency: 5-34 per minute
- Character:
- Active/Normal
- Clicks and gurgles
- Prolonged gurgles of hyperperistalsis, the familiar “stomach growling” referred to as borborygmi
-
Altered/Abnormal
- High-pitched tinkling
- Hyperactive
- Hypoactive
- Active/Normal
Bowel Sounds: High-pitched, tinkling bowel sounds
What are they an indication of?
Intestinal Obstruction (early): Normal flow of intestinal contents is interrupted. Intestinal fluid and air under tension in a dilated bowel. Multiple etiologies.
![](https://s3.amazonaws.com/brainscape-prod/system/cm/361/499/742/a_image_thumb.png?1635571991)
Bowel Sounds: Hyperactive bowel sounds
Cause?
- Diarrhea (gastroenteritis)
- Peritonitis (early)
Bowel Sounds: Hypoactive bowel sounds
How to assess?
Indication?
- Is it quiet, or is it silent?
- Listen for several minutes
- Ileus – little to no bowel activity (absent)
- Peritonitis – may be hyperactive initially, but eventually becomes hypoactive due to progressively severe inflammation, may progress to an ileus